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SAN JOAQUIN COUN i Y <br /> EP""RZONMENTAL HEALTH DEPARTMENT <br /> PAGE <br /> 304 Neber Ave.,Third Floor, Stockton, CA 9' <br /> (209)468-3420 <br /> UNDERGROUND STORAGE TANK (UST) PROGRAM INSPECTION REPORT <br /> Facility Address <br /> Facility Name <br /> Phone <br /> � — <br /> Title �� � <br /> Facilty ContacUST# Product______._ <br /> UST#_Product___ <br /> UST# Product�. UST#__ Product__ - <br /> Monitoring Panel: � � <br /> Violations: ❑Minor ❑ Major <br /> Overfill Prevention: ❑AudibleNisual ,a Mech�hical prNo <br /> piping System: d Gravity ❑ Pressure �rS6ction <br /> p ❑Yes ❑ No Dispenser Pan: 0 YesairlU rade <br /> Automatic Pum Shut Down Satisfies CCR 263 g): <br /> INSPECTION TYPE: C�>�outine C�Monitoring Certification ❑Complaint ❑Install `C�Removal ORep P <br /> COMPANY NAME: TECHNICIAN NAME: �. 1 ���=`��'�- <br /> VIOLATIONS) <br /> .:szu,•� <br /> 'lit is not in compliance with the following section(s) ofHealth & Safety Code (HSC) and/or <br /> The above facility California Code of Regulations (CCR): <br /> 20 ✓ CCR 2712 (b) Maintenance &monitoring <br /> HSC 25284 Permit to operate records <br /> 1Secondary cont testing (6 CCR 2636 (f)(4) Annual line tightness test <br /> 2__CCR 2637 21 Annual line leak detector test <br /> month/36 month) 22 ; CCR 2630 (d) <br /> 3 CCR 2711(b)& (c) Current State Forms A&B 2:=/ CCR 2630 (d) Annual monitoring certification <br /> Certification of financialCCR 2643 (d) Daily monitoring of suction <br /> 4�HSC 25292.2 24 piping that is not continuously <br /> ---- responsibility and letter from <br /> chief financial officer monitored <br /> CCR 2630 (d) Continuous monitoring system CCR 2643 (d) Triennial tightness test of <br /> 5 25 in that is not <br /> ---- for UST system suction piping <br /> CCR 2636 (c)(1) All releases in secondary piping continuously monitored <br /> 6-- flow to a collection sump Biennial tightness test of gravity <br /> y 2° cont 26 CCR 2643 (e) that is not continuously <br /> HSC 25291 (e) Water in secondary ( ) piping <br /> 7 Automatic line leak detector(s) monitored <br /> 8-HSC 25291 (f) CCR 2662 Upgrade requirements for UST <br /> CCR 2636 (f)(1) Continuous monitoring system 27 <br /> for underground piping system jr UST p itorri stem <br /> CCR 32 (c)(2) Continuous monitoring system CCR 2661 Permit to repa 10 26HSC 2528 29 Permit to alter monng <br /> for UST 291(a)(2) Secondary containment for system <br /> 25286 (a) <br /> 11 UST is tightIllegal abandonment of UST <br /> 12 system CCR 2636 (f)(1) Continuous monitoring system 30 HSC 25298 (a) Permit to temporarily close UST <br /> CCR 26 <br /> for dispenser system 31 HSC 25298 (b) <br /> 35 (b)(1) Spill container system <br /> 13 2 prevention system Permit to close UST system <br /> 14 CCR 2635 (b)( ) Overfill containment is product- 32 HSC 25298 (c) <br /> 15Water in 2° cont analyzed and <br /> __CCR 2631 (a) Primary g3 HSC 25291 (e) <br /> tight properly disposed of <br /> UST system is operated to 34 CCR 2640 (e) Single wall component within <br /> 16__HSC 25292.1 y 1000, of Public Well, no ELD <br /> prevent unauthorized release <br /> 17 CCR 2650 Recording/reporting 35 CCR 2635(a)(2)(A) Cathodic protection testing <br /> unauthorized release 36 H&SC 25299(a)(9)Disabling leak detect. devices <br /> CCR 2632 (d) Monitoring &response plan Violation(s) not listed above <br /> 18 Ian is 37 <br /> 19CCR 2712 (i) Monitoring & response p <br /> on site <br /> 4 PHONE: <br /> EHD INSPECTORS <br /> r <, I-TLE: PHONE: <br /> RECEIVED B`(, �. <br /> UNITIMST/INSP(rev 3!5/02) <br />